﻿#parse("partials/header.html") #parse("partials/sidebar.html")
<style type="text/css" media="all">
    div.dataTables_length label, div.dataTables_filter label
    {
        color: #fff;
    }
    .mws-table thead
    {
        border-top: 1px solid #ccc;
    }
    .row-align, .row-header th
    {
        text-align: center;
    }
    div.dataTables_wrapper .dataTables_filter
    {
        background-color: #333;
    }
    .mws-table thead
    {
        border-top: 1px solid #ccc;
    }
    .row-align, .row-header th
    {
        text-align: center;
    }
    .row-highlight
    {
        background-color: Yellow;
    }
</style>
<link rel="stylesheet" type="text/css" href="/Styles/smart_wizard.css" media="all" />
<script src="${rooturl}Scripts/jquery.blockUI.js" type="text/javascript"></script>
<script type="text/javascript" src="/Scripts/datatable/js/Scroller.js"></script>
<script type="text/javascript" src="/Scripts/jquery.smartWizard-2.0.min.js"></script>
<script type="text/javascript" src="/Scripts/MR/history_view.js"></script>
<!--<script type="text/javascript">
    $(document).ready(function () {
        $("td").click(function (e) {
            var currentCellText = $(this).text();
            var LeftCellText = $(this).prev().text();
            var RightCellText = $(this).next().text();
            var RowIndex = $(this).parent().parent().children().index($(this).parent());
            var ColIndex = $(this).parent().children().index($(this));
            var RowsAbove = RowIndex;
            var ColName = $(".head").children(':eq(' + ColIndex + ')').text();


            $("#para").text('')
        .append("<b>Current Cell Text: </b>" + currentCellText + "<br/>")
        .append("<b>Text to Left of Clicked Cell: </b>" + LeftCellText + "<br/>")
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        .append("<b>Column Name of Clicked Cell: </b>" + ColName)
        });
    });
</script>-->
<!--mws-container Start-->
<!-- Main Container Start -->
<div id="mws-container" class="clearfix">
    <!-- Inner Container Start -->
    <div class="container">
        <div id="para">
        </div>
        <div class="title-caption">
            <h5>
                $headerinformation - Medical Record</h5>
        </div>
        <!-- Smart Wizard -->
        <div id="wizard" class="swMain">
            <ul id="smart-wizard">
                <li><a href="#step-1">
                    <label class="stepNumber">
                        1</label>
                    <span class="stepDesc">Step 1<br />
                        <small>Medical Record</small> </span></a></li>
                <li><a href="#step-2">
                    <label class="stepNumber">
                        2</label>
                    <span class="stepDesc">Step 2<br />
                        <small>Charge Slip</small> </span></a></li>
            </ul>
            <div id="step-1">
                <div class="mws-panel grid_8">
                    <div class="mws-panel-header">
                        <!-- <input type="button" class="mws-button green small" style="position: absolute; right: 140px;
                            bottom: 1px;" value="Rx" />
                        <input type="button" class="mws-button green small" style="position: absolute; right: 90px;
                            bottom: 1px;" value="Rad" />
                        <input type="button" class="mws-button green small" style="position: absolute; right: 41px;
                            bottom: 1px;" value="Lab" />-->
                    </div>
                    <div class="mws-panel-body">
                        <div class="mws-panel-content">
                            <div class="mws-form">
                                <div class="mws-form-cols clearfix">
                                    <div class="mws-form-col-1-8 alpha">
                                        <label>
                                            MR No.</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="MRNo" value="$MRNo" id="mrno" readonly="readonly" />
                                        </div>
                                    </div>
                                    <div class="mws-form-col-2-8">
                                        <label>
                                            Patient Name</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="PatientName" value="$PatientName"
                                                id="patientname" readonly="readonly" />
                                        </div>
                                    </div>
                                    <div class="mws-form-col-1-8">
                                        <label>
                                            Age</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="Age" value="$Age" id="age" readonly="readonly" />
                                        </div>
                                    </div>
                                    <div class="mws-form-col-1-8">
                                        <label>
                                            Gender</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="Gender" value="$Gender" id="gender"
                                                readonly="readonly" />
                                        </div>
                                    </div>
                                    <div class="mws-form-col-1-8">
                                        <label>
                                            Weight (kg)</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="Weight" value="$Weight" id="weight" />
                                        </div>
                                    </div>
                                    <div class="mws-form-col-1-8">
                                        <label>
                                            Height (cm)</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="height" value="$Height" id="height" />
                                        </div>
                                    </div>
                                    <div class="mws-form-col-1-8 omega">
                                        <label>
                                            Room</label>
                                        <div class="mws-form-item large">
                                            <input type="text" class="mws-textinput" name="Room" value="$Room" id="room" readonly="readonly" />
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div id="mws-tabs-preview">
                                <ul>
                                    <li><a href="#tab-allergies">Allergies</a></li>
                                    <li><a href="#tab-medical">Medical History</a></li>
                                    <li><a href="#tab-family">Family History</a></li>
                                    <li><a href="#tab-habit">Habit</a></li>
                                    <li><a href="#tab-occupation">Occupation</a></li>
                                    <li><a href="#tab-problem">Problem List</a></li>
                                </ul>
                                <!--allergies-->
                                <div id="tab-allergies">
                                    <div id="notif">
                                    </div>
                                    <form method="post" action="/patientdata/medicalrecord/saveallergies/?patientid=$PatientId"
                                    class="crud" id="allergies-view">
                                    <div class="mws-form">
                                        <div class="mws-form-cols clearfix">
                                            <div class="mws-form-col-1-8 alpha">
                                                <label>
                                                    Allergies To</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" name="allergies-to" id="allergies-to" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-2-8">
                                                <label>
                                                    Brand</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" name="brand-allergies-view" id="brand-allergies-view" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-2-8">
                                                <label>
                                                    Generic</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" name="generic-allergies-view" id="generic-allergies-view" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-2-8">
                                                <label>
                                                    Description</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" name="description-allergies-view" id="description-allergies-view" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-1-8 omega">
                                                <label>
                                                    &nbsp;</label>
                                                <div class="mws-form-item large">
                                                    <select name="is-subjective-allergies">
                                                        <option value="0">Subjective</option>
                                                        <option value="1">Objective</option>
                                                    </select>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="mws-button-row">
                                            <input id="btnSaveAllergiesView" type="submit" value="Save" class="mws-button red" />
                                            <input class="mws-button gray" type="reset" value="Reset" />
                                        </div>
                                    </div>
                                    </form>
                                    <table cellpadding="0" cellspacing="0" border="0" class="fullwidth mws-table" id="tablelist-allergies"
                                        width="100%">
                                        <thead>
                                            <tr class="row-header">
                                                <th>
                                                    Action
                                                </th>
                                                <th>
                                                    Allergies To
                                                </th>
                                                <th>
                                                    Brand
                                                </th>
                                                <th>
                                                    Generic
                                                </th>
                                                <th>
                                                    Descriptions
                                                </th>
                                                <th>
                                                    Subjective?
                                                </th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                            <tr>
                                                <td colspan="7" class="dataTables_empty">
                                                </td>
                                            </tr>
                                        </tbody>
                                    </table>
                                </div>
                                <!--Medical History-->
                                <div id="tab-medical">
                                    <div class="mws-form">
                                        <form method="post" action="/patientdata/medicalrecord/savemedicalhistory/?patientid=$PatientId"
                                        class="crud" id="medical-histories-view">
                                        <div class="mws-form-cols clearfix">
                                            <div class="mws-form-col-7-8 alpha">
                                                <label>
                                                    Disease History</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="diseasehistory-medical" name="diseasehistory-medical" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-1-8 omega">
                                                <label>
                                                    Year</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="year" name="year" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="mws-button-row">
                                            <input id="btnSaveMedical" type="submit" value="Save" class="mws-button red" />
                                        </div>
                                        </form>
                                    </div>
                                    <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-medical-histories"
                                        width="100%">
                                        <thead>
                                            <tr class="row-header">
                                                <th>
                                                    Action
                                                </th>
                                                <th>
                                                    Disease
                                                </th>
                                                <th>
                                                    Year
                                                </th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                        </tbody>
                                    </table>
                                </div>
                                <!--Family History-->
                                <div id="tab-family">
                                    <div class="mws-form">
                                        <form method="post" action="/patientdata/medicalrecord/savefamilyhistory/?patientid=$PatientId"
                                        class="crud" id="family-histories-view">
                                        <div class="mws-form-cols clearfix">
                                            <div class="mws-form-col-7-8 alpha">
                                                <label>
                                                    Disease History</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="diseasehistory-family" name="diseasehistory-family" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-1-8 omega">
                                                <label>
                                                    Relations</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="relations" name="relations" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="mws-button-row">
                                            <input id="btnSaveFamily" type="submit" value="Save" class="mws-button red" />
                                        </div>
                                        </form>
                                    </div>
                                    <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-family-histories"
                                        width="100%">
                                        <thead>
                                            <tr class="row-header">
                                                <th>
                                                    Action
                                                </th>
                                                <th>
                                                    Disease
                                                </th>
                                                <th>
                                                    Relations
                                                </th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                        </tbody>
                                    </table>
                                </div>
                                <!--Habit-->
                                <div id="tab-habit">
                                    <div class="mws-form">
                                        <form method="post" action="/patientdata/medicalrecord/savehabits/?patientid=$PatientId"
                                        class="crud" id="habits-view">
                                        <div class="mws-form-cols clearfix">
                                            <div class="mws-form-col-4-8 alpha">
                                                <label>
                                                    Habit</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="habit-description" name="habit-description" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-2-8">
                                                <label>
                                                    Quantity</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="quantity" name="quantity" />
                                                </div>
                                            </div>
                                            <div class="mws-form-col-2-8 omega">
                                                <label>
                                                    Duration</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="duration" name="duration" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="mws-button-row">
                                            <input id="btnSaveHabit" type="submit" value="Save" class="mws-button red" />
                                        </div>
                                        </form>
                                    </div>
                                    <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-habits"
                                        width="100%">
                                        <thead>
                                            <tr class="row-header">
                                                <th>
                                                    Action
                                                </th>
                                                <th>
                                                    Habit
                                                </th>
                                                <th>
                                                    Quantity
                                                </th>
                                                <th>
                                                    Duration
                                                </th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                        </tbody>
                                    </table>
                                </div>
                                <!--Occupation-->
                                <div id="tab-occupation">
                                    <div class="mws-form">
                                        <form method="post" action="/patientdata/medicalrecord/saveoccupation/?patientid=$PatientId"
                                        class="crud" id="occupation-view">
                                        <div class="mws-form-cols clearfix">
                                            <div class="mws-form-col-8-8 omega">
                                                <label>
                                                    Occupation</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="occupation-description" name="occupation-description" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="mws-button-row">
                                            <input id="btnSaveOccupation" type="submit" value="Save" class="mws-button red" />
                                        </div>
                                        </form>
                                    </div>
                                    <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-occupation"
                                        width="100%">
                                        <thead>
                                            <tr class="row-header">
                                                <th>
                                                    Action
                                                </th>
                                                <th>
                                                    Occupation
                                                </th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                        </tbody>
                                    </table>
                                </div>
                                <!--problem list-->
                                <div id="tab-problem">
                                    <div class="mws-form">
                                        <form method="post" action="/patientdata/medicalrecord/saveproblemlist/?patientid=$PatientId"
                                        class="crud" id="problemlist-view">
                                        <div class="mws-form-cols clearfix">
                                            <div class="mws-form-col-8-8 omega">
                                                <label>
                                                    Problem List</label>
                                                <div class="mws-form-item large">
                                                    <input type="text" class="mws-textinput" id="problem-list-description" name="problem-list-description" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="mws-button-row">
                                            <input id="btnSaveProblemListView" type="submit" value="Save" class="mws-button red" />
                                        </div>
                                        </form>
                                    </div>
                                    <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-problem-list-view"
                                        width="100%">
                                        <thead>
                                            <tr class="row-header">
                                                <th>
                                                    No
                                                </th>
                                                <th>
                                                    Problem
                                                </th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                        </tbody>
                                    </table>
                                </div>
                            </div>
                            <div id="mws-tabs-mr">
                                <ul>
                                    <li><a href="#tab-mr">Medical Record</a></li>
                                    <li><a href="http://localhost:69/patientdata/medicalhistorypatient/loadtabhistories/">
                                        Histories</a></li>
                                </ul>
                                <!--medical record-->
                                <div id="tab-mr">
                                    <div class="mws-form">
                                        <div class="mws-form-inline">
                                            <div class="mws-form-row">
                                                <label>
                                                    Date & Time</label>
                                                <div class="mws-form-item large">
                                                    <div class="mws-form-cols clearfix">
                                                        <div class="mws-form-col-2-8 alpha">
                                                            <div class="mws-form-item">
                                                                <input type="text" class="mws-textinput">
                                                            </div>
                                                        </div>
                                                        <div class="mws-form-col-6-8 omega">
                                                            <div class="mws-form-item">
                                                                &nbsp;
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <br />
                                        <hr />
                                    </div>
                                    <div class="mws-panel grid_8">
                                        <div class="mws-panel-header">
                                            <span class="mws-i-24 i-documents-1">Subjective</span></div>
                                        <div class="mws-panel-body">
                                            <div class="mws-panel-content">
                                                <div class="mws-form">
                                                    <div class="mws-form-block">
                                                        <div class="mws-form-row">
                                                            <div class="mws-form-item large">
                                                                <textarea cols="100%" rows="100%"></textarea>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="mws-panel grid_8">
                                        <div class="mws-panel-header">
                                            <span class="mws-i-24 i-documents-1">Objective</span></div>
                                        <div class="mws-panel-body">
                                            <div class="mws-panel-content">
                                                <div class="mws-form">
                                                    <div class="mws-form-block">
                                                        <div class="mws-form-row">
                                                            <div class="mws-form-item large">
                                                                <textarea cols="100%" rows="100%"></textarea>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="mws-panel grid_8">
                                        <div class="mws-panel-header">
                                            <span class="mws-i-24 i-documents-1">Assesment</span></div>
                                        <div class="mws-panel-body">
                                            <div class="mws-panel-content">
                                                <div class="mws-form">
                                                    <div class="mws-form-block">
                                                        <div class="mws-form-row">
                                                            <div class="mws-form-item large">
                                                                <textarea cols="100%" rows="100%"></textarea>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="mws-form-inline">
                                                        <div class="mws-form-row">
                                                            <label>
                                                                Problem List</label>
                                                            <div class="mws-form-item large">
                                                                <input type="text" class="mws-textinput">
                                                            </div>
                                                        </div>
                                                        <div class="mws-form-row">
                                                            <label>
                                                                Diagnose</label>
                                                            <div class="mws-form-item large">
                                                                <input type="text" class="mws-textinput">
                                                            </div>
                                                        </div>
                                                        <div class="mws-form-row">
                                                            <label>
                                                                ICD Code</label>
                                                            <div class="mws-form-item large">
                                                                <input type="text" class="mws-textinput">
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="mws-panel grid_8">
                                        <div class="mws-panel-header">
                                            <span class="mws-i-24 i-documents-1">Plan</span></div>
                                        <div class="mws-panel-body">
                                            <div class="mws-panel-content">
                                                <div class="mws-form">
                                                    <div class="mws-form-block">
                                                        <div class="mws-form-row" style="padding-bottom: 10px; padding-top: 10px;">
                                                            <div class="mws-form-item large">
                                                                <textarea cols="100%" rows="100%">
                                                        
                                                        </textarea>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="mws-accordion">
                                                    <h3>
                                                        <a href="#">Medical Record</a></h3>
                                                    <div>
                                                        <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-medication-record-history"
                                                            width="100%">
                                                            <thead>
                                                                <tr class="row-header">
                                                                    <th>
                                                                        Action
                                                                    </th>
                                                                    <th>
                                                                        Date & Time
                                                                    </th>
                                                                    <th>
                                                                        Medication
                                                                    </th>
                                                                    <th>
                                                                        Route
                                                                    </th>
                                                                    <th>
                                                                        Dose
                                                                    </th>
                                                                    <th>
                                                                        Freq
                                                                    </th>
                                                                    <th>
                                                                        Total Qty
                                                                    </th>
                                                                </tr>
                                                            </thead>
                                                            <tbody>
                                                            </tbody>
                                                        </table>
                                                        <br />
                                                        <table cellpadding="0" cellspacing="0" border="0" class="mws-table" id="tablelist-medication-record"
                                                            width="100%">
                                                            <thead>
                                                                <tr class="row-header">
                                                                    <th>
                                                                        Medication Name
                                                                    </th>
                                                                    <th>
                                                                        Dose
                                                                    </th>
                                                                    <th>
                                                                        Frequency
                                                                    </th>
                                                                    <th>
                                                                        Quantity
                                                                    </th>
                                                                    <th>
                                                                        Remark
                                                                    </th>
                                                                    <th>
                                                                        Freq
                                                                    </th>
                                                                    <th>
                                                                        Total Qty
                                                                    </th>
                                                                </tr>
                                                            </thead>
                                                            <tbody>
                                                            </tbody>
                                                        </table>
                                                    </div>
                                                    <h3>
                                                        <a href="#">LAB</a></h3>
                                                    <div>
                                                        <p>
                                                            Sed non urna. Donec et ante. Phasellus eu ligula. Vestibulum sit amet purus. Vivamus
                                                            hendrerit, dolor at aliquet laoreet, mauris turpis porttitor velit, faucibus interdum
                                                            tellus libero ac justo. Vivamus non quam. In suscipit faucibus urna.
                                                        </p>
                                                    </div>
                                                    <h3>
                                                        <a href="#">Radiology</a></h3>
                                                    <div>
                                                        <p>
                                                            Nam enim risus, molestie et, porta ac, aliquam ac, risus. Quisque lobortis. Phasellus
                                                            pellentesque purus in massa. Aenean in pede. Phasellus ac libero ac tellus pellentesque
                                                            semper. Sed ac felis. Sed commodo, magna quis lacinia ornare, quam ante aliquam
                                                            nisi, eu iaculis leo purus venenatis dui.
                                                        </p>
                                                        <ul>
                                                            <li>List item one</li>
                                                            <li>List item two</li>
                                                            <li>List item three</li>
                                                        </ul>
                                                    </div>
                                                    <h3>
                                                        <a href="#">Procedure</a></h3>
                                                    <div>
                                                        <div style="margin: 10px;">
                                                            <input type="button" class="mws-button green small" value="LDS">
                                                            <input type="button" class="mws-button green small" value="OT">
                                                            <input type="button" class="mws-button green small" value="Cathlab">
                                                            <input type="button" class="mws-button green small" value="Rehab">
                                                            <input type="button" class="mws-button green small" value="Radiology">
                                                            <input type="button" class="mws-button green small" value="HD">
                                                            <input type="button" class="mws-button green small" value="MCU">
                                                            <input type="button" class="mws-button green small" value="IPD">
                                                            <input type="button" class="mws-button green small" value="OPD">
                                                            <input type="button" class="mws-button green small" value="ICU">
                                                            <input type="button" class="mws-button green small" value="TC">
                                                            <input type="button" class="mws-button green small" value="LAB">
                                                        </div>
                                                    </div>
                                                    <h3>
                                                        <a href="#">Diet</a></h3>
                                                    <div>
                                                        <p>
                                                            Cras dictum. Pellentesque habitant morbi tristique senectus et netus et malesuada
                                                            fames ac turpis egestas. Vestibulum ante ipsum primis in faucibus orci luctus et
                                                            ultrices posuere cubilia Curae; Aenean lacinia mauris vel est.
                                                        </p>
                                                        <p>
                                                            Suspendisse eu nisl. Nullam ut libero. Integer dignissim consequat lectus. Class
                                                            aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos.
                                                        </p>
                                                    </div>
                                                    <h3>
                                                        <a href="#">Education</a></h3>
                                                    <div>
                                                        <div class="mws-form">
                                                            <div class="mws-form-inline">
                                                                <div class="mws-form-row">
                                                                    <label>
                                                                        Document</label>
                                                                    <div class="mws-form-item small">
                                                                        <input type="text" class="mws-textinput">
                                                                    </div>
                                                                </div>
                                                                <div class="mws-form-row">
                                                                    <label>
                                                                        Description</label>
                                                                    <div class="mws-form-item large">
                                                                        <textarea cols="100%" rows="100%"></textarea>
                                                                    </div>
                                                                </div>
                                                                <div class="mws-form-row">
                                                                    <label>
                                                                        Education Modules</label>
                                                                    <div class="mws-form-item large">
                                                                        <textarea cols="100%" rows="100%"></textarea>
                                                                    </div>
                                                                </div>
                                                                <div class="mws-form-row">
                                                                    <label>
                                                                        Educator</label>
                                                                    <div class="mws-form-item medium">
                                                                        <input type="text" class="mws-textinput">
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="mws-button-row">
                                                                <input type="submit" class="mws-button red" value="Submit">
                                                                <input type="reset" class="mws-button gray" value="Reset">
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="clearfix">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="clearfix">
                                    </div>
                                </div>
                                <!--medical histories-->
                                <div id="tab-mr-histories">
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
            <div id="step-2">
                <h2 class="StepTitle">
                    Step 2 Content</h2>
                <p>
                    Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor
                    incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud
                    exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute
                    irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla
                    pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia
                    deserunt mollit anim id est laborum.
                </p>
                <p>
                    Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor
                    incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud
                    exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute
                    irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla
                    pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia
                    deserunt mollit anim id est laborum.
                </p>
                <p>
                    Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor
                    incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud
                    exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute
                    irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla
                    pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia
                    deserunt mollit anim id est laborum.
                </p>
                <p>
                    Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor
                    incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud
                    exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute
                    irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla
                    pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia
                    deserunt mollit anim id est laborum.
                </p>
            </div>
        </div>
        <div class="clearfix">
        </div>
    </div>
    <!-- End SmartWizard Content -->
</div>
<!-- Inner Container End -->
#parse("partials/footer.html")